A leaked document shows a group of NHS managers want to force staff to take pay cuts of up to 5 per cent, end overtime payments for working nights, weekends and bank holidays, reduce holiday and introduce longer shifts.

NHS bosses from 19 organisations have joined together, in what some have dubbed a ‘pay cartel’, to drive through the changes.

It could mean the end of the national contract called Agenda for Change, which saw the majority of health service staff, including nurses, midwives and porters, moved onto a standardised pay scale.

Doctors are on different contracts and are not affected.

Andrew Lansley, the Health Secretary, is thought to be sympathetic to regional pay and conditions as NHS bosses struggle to make £20bn worth of efficiency savings over four years.

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Others believe that the NHS terms and conditions are a barrier to private companies taking on patient services and breaking up Agenda for Change would make it more attractive.

The 19 chief executives believe that by acting together they can counter the ‘extremely hostile’ reaction expected by staff, it has been reported.

The document leaked to the Sunday Times said: “Acting in unison... in a way which has not been undertaken previously demonstrates both the seriousness of the situation and the collective resolve to achieve long-term change.”

Hospital staff in Poole, Exeter, Plymouth and Turo are thought to be among the 1.5m who could be affected.

Demonstrations have already been held and it is expected that the unions would put up a strong fight to protect national pay.

Unison has said the plans will “damage patient care and drive down pay’.

The document outlines measures such as a sliding scale pay cut with those on more than £21,000 a year set to lose around 5 per cent, reducing sick and stopping unsocial hours payments.

Performance related awards could soften the blow for staff in what the document calls a ‘sweet and sour’ approach.

The ‘final option’ could be to terminate all contracts and reemploy staff on the new terms although the document said this is likely to result in the NHS being sued.

It said: “Making the potentially radical changes to the terms and conditions of employment of our staff is not without risk in terms of legal challenge, industrial relations unrest, impact on staff morale and reputation management.”

It added: “Organisations must appreciate that upon entering into a negotiation, there is a very real need to see it through and to deliver some change.”

Two thirds of the NHS budget is spent on staff and it is already thought that thousands of posts have been lost as bosses fail to recruit into vacancies.

Management consultants have suggested that the NHS should lose one in ten of its 1.4m workforce in order to save money.

Shadow Health Secretary Andy Burnham said: “"A clear sign of the chaos engulfing the NHS is the move by a break-away group to cut pay and break national pay arrangements - in open defiance of a promise by the Deputy Prime Minister to prevent regional pay.

"Labour will force a Commons vote on the Government's NHS betrayal and call on the Treasury to return £700m to the Department of Health to fulfil its election promises.

"On Cameron's watch, we are seeing budget cuts, job losses and a postcode lottery running riot. They inherited a successful NHS and in just two years have reduced it to a demoralised and destabilised service that is fearful of the future.”

A Department Of Health spokesman said: "NHS providers have long had the power to employ staff on such terms that they consider appropriate, including under the foundation trust laws passed under the previous government. This means employers are free to negotiate any changes to national agreements directly with staff locally or their representatives.

"We would expect NHS employers and trade unions to work together to ensure the national Agenda for Change pay scheme remains fit for purpose."